MEDICARE: TONI EVANGELINE TEAGUE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SCO6359800	NJ

General Provider Information

NPI Number	:	1144046236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONI EVANGELINE TEAGUE

Provider Business Mailing Address
First Line	:	24 COOPER DR FL 1
Second Line	:
City	:	BOONTON
State	:	NJ
Zip	:	07005-1212
Country	:	US
Telephone Number	:	973-462-0186
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 MORRIS AVE STE C206
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-5739
Country	:	US
Telephone Number	:	908-891-2727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2024
Last Update Date	:	11/23/2024

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Directions to “ TONI EVANGELINE TEAGUE ” Practice Location

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